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RA644.D6  IL6  1 907    Diphtheria,  its  prev 


RECAP 


Illinois.  Dept.  of  public  health. 
Diphtheria. 


CoUcse  of  ^fjpgicianiS  anb  ^urgeong 
Hibrarp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/diphtheriaitspreOOilli 


DIPHTHERIA 


ITS 


PREVENTION,  RESTRICTION  AND  SUPPRESSION 


ISSUED   BY 


THE  ILLINOIS  STATE  BOARD  OF  HEALTH 

1907. 

REVISED  EDITION 


Please  P^-e serve  for  Ftiiure  Use. 


Should  a  case  of  Diphtheria  occur  near  you,  you  can  do  yourself 

and  your  community  a  gfreat  gfood  by  seeing:  that 

the  family  has  one  of  these  pamphlets. 


Copies  can  be  obtained  by  any  resident  of  Illinois,  without  cost,  by  addressing 
the  Secretary  at  Springfield. 


Springfield,  III. 

Illinois  State  Register 

1907 


E-xamples  of  tHe  Manner  in  "WKicK  DipKtKeria 
May  be  Contracted. 


A  teacher  developed  diphtheria  from  passing  the  night  in  a  room  in 
which  three  weeks  hefore  a  fatal  case  had  occurred.  A  child  developed 
diphtheria  after  putting  on  the  clothing  worn  by  a  child  which  had 
died  of  diphtheria  two  months  before.  In  a  number  of  isolated  dwellings 
diphtheria  developed  nearly  a  year  after  previous  outbreaks^  without 
there  being  any  apparent  possibility  of  a  new  infection  taking  place 
from  the  outside.  I  have  met  with  a  number  of  cases  where  the 
infected  bedding  or  clothing  has  undoubtedly  been  the  source  of  the 
infection. — From  American  System  of  Practical  Medicine,  Loomis- 
Thompson. 


DISIXFECTIOX   OF   HOUSES. 

A  very  wholesome  practice  that  bids  fair  to  become  an  established 
custom  is  the  disinfection  of  a  rented  house  before  a  new  family  moves 
into  it.  This  is  done,  now,  where  a  case  of  very  contagious  disease,  say 
smallpox,  or  diphtheria,  has  been  known  to  exist;  but  how  can  we  feel 
sure  that  the  house  we  are  about  to  move  into  and  live  in  has  not  had  in 
it  an  imrecognized  or  a  suppressed  case  of  measles,  scarlet  fever,  or 
tuberculosis  or  typhoid  fever  ?  Disinfection,  after  these  diseases  is  of  the 
highest  importance.  Then,  again,  there  are  those  diseases  that  are  not 
fatal,  perhaps,  but,  being  communicable,  may  become  certainly  afiiic- 
tions,  nuisances.  This  precaution  therefore  should  be  demanded  of 
every  landlord  by  those  who  are  planning  to  rent  the  house. — Public 
Health,  Michigan. 


DIPHTHERIA. 


ITS  PIJEVENTIO^,  EESTRICTION  AND  SUPPEESSION. 


Issued  by  the  Illinois  State  Board  of  Health. 
1907. 


ITS  SANITARY  FEATURES. 

Diphtheria  is  a  highly  contagioiis  disease,  rapidly  comiimnicated 
from  person  to  person. 

The  infection  of  diphtheria  is  contained  in  particles  or  shreds  of 
the  diphtheretic  membrane  or  in  the  expired  air.  These  are  communicated 
by  direct  contact  with  the  patient,  by  inhaling  the  air  surrounding  him, 
and  by  coming  in  contact  with  articles  used  in  the  sick  room,  such  as 
carpets,  bed  clothes,  clothing,  books  and  toys.  The  infection  clings 
tenaciously  to  these  articles.  The  virus  may  remain  dormant  in  dwell- 
ings for  a  long  period,  and  unless  destroyed  by  disinfection,  may  give  rise 
to  a  new  outbreak. 

Filth  plays  a  very  important  part  in  the  spread  of  diphtheria,  for 
unsanitary  conditions  tend  to  lower  vitality,  and,  in  consequence,  to 
increase  the  susceptibility  to  the  disease.  There  is  no  doubt,  also,  that 
sewer  gas  may  be  a  carrier  of  diphtheritic  poison  and  that  many  out- 
breaks hold  a  close  relationship  with  defective  drainage,  sewers  and 
cesspools. 

Over-crowding,  faulty  ventilation  and  filthy  conditions  of  habitation 
favor  the  spread  of  the  disease,  as  do  also  soil  moisture,  damp  cellars 
and  general  dampness  of  houses. 

"Intentions,  like  eggs,  unless  hatched  into  action,  will  run  into 
rottenness." 


2 

It  is  possible  that  diphtheria  may  be  comm-unicated  by  dogs,  fowls, 
pigeons  and  the  like.  It  is  known  that  cats  are  susceptible  to  human 
diphtheria  and  are  capable  of  communicating  the  disease  to  other  cats 
and  also  to  human  beings. 

Children  under  fifteen  are  usually  most  susceptible  to  diphtheria, 
although  adults  may  be  attacked  with  fatal  results.  The  disease  is 
most  fatal  "between  the  second  and  fifth  years.  A  healthy  child  is  not 
as  susceptible  to  diphtheria  as  one  whose  vitality  has  been  weakened  by 
unsanitary  conditions. 

A  person  may  have  diphtheria  more  than  once. 

Whenever  diphtheria  exists  in  malignant  form,  there  will  generally 
be  found  some  obvious  cause,  such  as  accumulation  of  filth,  unclean 
cellars,  foul  gutters  or  cesspools  or  overflowing  privy  vaults. 

Every  case  of  diphtheria  is  dangerous  to  life.  A  physician  should 
be  called  early  whenever,  on  examining  the  throat  of  a  sick  child,  it  is  found 
swollen  and  red,  and  if  there  is  evidence  of  the  appearance  of  white, 
gray  or  yellow  membrane.  A  delay  may  be  fatal  to  the  patient.  The 
treatment  of  diphtheria  is  most  efEective  if  commenced  within  twenty- 
four  hours  after  the  appearance  of  the  membrane. 

"Delay  always  breeds  danger." 

Membranous  Croup. — The  majority  if  not  all  cases  of  so-called  mem- 
branous croup  are  laryngeal  diphtheria,  the  membrane  being  usually 
limited  to  the  upper  part  of  the  windpipe.  In  these  cases  an  inspection 
of  the  throat  may  or  may  not  show,  the  presence  of  the  membrane.  With-' 
out  a  bacterial  examination,  the  facilities  for  which  are  seldom  available 
except  in  cities,  it  is  impossible  at  the  onset  to  differentiate  diphtheritic 
from  benign  croup.  As  the  majority  of  cases  of  membranous  croup, 
however,  have  been  found  to  be  genuine  diphtheria,  all  cases  of  mem- 
branous ■  croup  should,  in  the  interests  of  the  lives  and  health  of  the » 
children  of  the  state,  be  considered  diphtheria,  so  far  as  isolation,  quar- 
antine and  disinfection  are  concerned. 


PKEVENTION,   RESTRICTION"  AND  SUPPRESSION. 

Diphtheria  is  a  preventable  disease.  A  rigid  observance  of  the 
rules  of  the  State  Board  of  Health  will  often  prevent  the  introduction 
of  the  disease,  and  is  always  followed  by  a  limitation  of  the  disease  to 
the  first  case  or  cases.  If  diphtheria  spreads  from  one  house  to 
another  some  one  is  to  blame.  The  parents  who  permit  their  children 
to  enter  a  house  in  which  they  know,  or  suspect,  there  is  a  case  of  diph- 
theria, or  to  play  or  mingle  with  children  from  that  house,  need  not 
attribute  the  sickness  and  subsequent  death  of  one  of  their  loved  ones 
to  the  mysterious  dispensation  of  Divine  Providence.  The  parents  who 
fail  to  make  known  the  existence  of  diphtheria  in  their  houses,  who 
allow  the  children  of  their  families  to  go  to  school  and  mingle  otherwise 
with  other  children,  and  who,  during  the  period  of  sickness,  disregard  all 
health  laws  and  sanitary  precautions,  are  morally  responsible  for  what- 
ever sickness  and  death  may  occur  through  their  negligence. 

Observe  the  Golden  Rule. 

The  local  health  authorities,  who,  after  being  advised  of  the  presence 
of  diphtheria  in  a  family,  fail  to  quarantine  the  premises,  and  to  insist 
on  the  isolation  of  the  patient  and  compliance  with  all  precautions  neces- 
sary to  prevent  the  spread  of  the  disease,  are  gnilty  of  culpable  negligence. 

During  the  existence  of  diphtheria  or  scarlet  fever  in  a  community, 
all  cases  of  sore  throat  with  fever  are  to  be  looked  upon  with  suspicion 
until  their  innocent  character  is  established. 

Whenever  a  child  has  sore  throat  and  fever,  he  or  she  should  be  at  once 
separated  from  other  members  of  the  family  until  a  physician  has 
passed  an  opinion  on  the  nature  of  the  ailment.  This  precaution  should 
never  be  neglected,  especially  if  the  child  vomits  or  has  a  chill,  or  is 
sluggish  and  languid,  and  looks  heavy-eyed.  By  '^separated"  is  meant 
placed  in  a  room  apart  as  far  as  possible  from  other  rooms  in  the  house. 
From  this  room  all  other  children  must  be  kept. 

A  child  is  attacked  with  diphtheria  usually  within  two  or  four  days, 
after  exposure.  The  disease  may  come  on  within  12  hours  after  the 
child  has  come  in 'contact  with  the  poison,  and,  again,  no  symptoms  may 
develop  until  the  seventh  day.  If  a  child  does  not  show  signs  of  illness 
by  the  tenth  day  it  can  be  safely  concluded  that  the  disease  has  not  been 
contracted.  A  child  known  to  have  been  exposed  should  be  carefully 
watched  for  a  week  or  ten  days,  and  on  the  slightest  sign  of  illness,  be 
separated  from  all  others. 


4 

Keep  away  from  the  sources  of  contagion.  Do  not  go  where  the 
disease  is  if  you  can  avoid  it,  and  do  not  let  your  children  go  near  an 
infected  dwelling  or  mingle  with  children  or  others  coming  from  the 
premises.  If  you  know  that  children  from  infected  houses  are  permitted 
to  attend  school,  withdraw  your  children  from  that  school,  should  they 
be  in  attendance,  and  notify  the  State  Board  of  Health.  Permit  no  one 
to  enter  your  house  who  has  been  exposed  to  diphtheria.  During  the 
prevalence  of  diphtheria,  in  epidemic  form  especially,  avoid  all  public 
gatherings  and  keep  your  children  away  from  such. 

"To  fear  the  worst  often  cures  the  worst." 

At  all  times,  and  especially  during  the  prevalence  of  disease,  keep 
your  premises  and  its  surroundings, — your  yard,  outhouses,  cellars, — in  a 
sanitary  condition.  Allow  no  filth  to  accumulate.  Draw  off  all  pools 
of  stagnant  water.  Burn  all  rubbish.  Use  disinfectants  freely ;  they  are 
cheap,  sickness  is  costly.  Bear  in  mind  continually  that  while  filth  may 
not  cause  diphtheria  it  is  nevertheless  a  fact  beyond  controversy  that  the 
spread  of  diphtheria  is  influenced  largely  by  unsanitary  conditions,  which 
induce  an  unhealthy  condition  of  the  throat  and  provide  a  suitable  soil 
or  breeding  ground  for  the  germ  of  the  disease.  A  healthy  child,  though 
exposed  to  diphtheria,  may  not  contract  the  disease;  one  whose  vitality 
is  weakened  through  the  influence  of  unsanitary  surroundings  is  very 
susceptible  to  the  virus. 

When  diphtheria  prevails  in  the  neighborhood, — and  at  all  times, — 
warn  your  children  not  to  use,  while  in  school,  the  pencils,  books,  etc., 
of  other  children,  and  especially  not  to  put  into  their  mouths  pencils, 
toys,  harmonicas,  jewsharps,  and  the  like,  which  may  have  been  handled 
by  other  children.  Warn  them  also  to  thoroughly  rinse  the  school  room 
drinking  cup  before  using. 

A  "sore  throat"  in  an  adult  may  mean  diphtheria  in  a  child.  Be 
careful  not  to  allow  children  to  use  dishes  and  other  utensils  which 
have  been  used  by  adults  having  "sore  throats."  Under  no  circumstances 
should  such  adults  kiss  children. 

It  is  better,  when  diphtheria  exists  in  your  family,  to  send  the 
children,  who  are  not  affected,  elsewhere.  Do  not,  however,  run  the  risk 
of  communicating  the  disease  to  other  children.  In  this,  and  in  all 
other  matters  relative  to  disease  in  your  household,  consult  your  physician. 

"Do  as  you  would  be  done  by." 


5 

Engage  the  services  of  a  competent  physician  earl}'  in  all  contagious 
diseases.  Do  not  wait  until  it  is  too  late,  when  regrets  are  useless.  You 
may  not  feel  able  to  incur  the  necessary  expense  incident  to  sickness; 
you  likewise  may  not  feel  able  to  pay  those  always  attendant  upon  a 
death. 

Eemember  that  diphtheria  is  a  preventable  disease.  Eemember,  also, 
that  the  period  of  sickness  can  be  much  shortened  and  the  possible  bad 
effects  of  the  disease  entirely  prevented  if  competent  medical  attendance 
is  obtained  early. 

Avoid,  as  you  would  the  presence  of  evil,  those  individuals,  "old 
women"  of  both  sexes,  who  "know  more  than  the  doctor";  who  insist 
that  your  child  suffers  from  "putrid  sore  throat,"  and  that  the  ailment  is 
not  contagious.  Countless  graves  are  filled  with  the  bodies  of  innocent 
children,  in  whose  little  throats  the  deadly  germ  of  diphtheria  was 
allowed  to  prey  unmolested,  while  these  oracles  in  health  and  hygiene, 
often  persons  not  knowing  even  the  rudiments  of  anatomy  and  physiology, 
taught  in  the  common  schools,  gravely  diagnosed  the  ailment  as  "putrid 
sore  throat." 

"Nothing  is  more  terrible  than  active  ignorance." 

ISOLATION  AJs^D  DISINFECTIOISr. 

Diphtheria  is  a  most  highly  contagious  disease,  readily  communicated 
from  person  to  person.  As  it  is  difficult  often  at  the  onset  of  a  "'sore 
throat"  to  determine  whether  the  ailment  is  diphtheria  or  not,  to  be 
on  the  safe  side,  the  sufferer  should  be  isolated  until  medical  advice  can 
be  obtained.  "An  ounce  of  prevention,"  here  as  elsewhere,  "is  worth  a 
pound  of  cure."  By  "isolated"  is  meant  kept  away  from  other  persons 
as  much  as  possible.  For  this  purpose  a  room  on  the  upper  floor,  away 
from  the  direct  line  of  passage,  should  be  selected. 

The  room  of  a  person  sick  with  diphtheria  should  be  large  and  easily 
aired.  It  must  be  kept  well  ventilated.  There  should  be  taken  out  of 
the  room  all  ornaments,  carpets,  table  covers,  draperies,  plush  chairs  and 
other  things  that  are  not  needed  in  it.  Dogs,  cats,  birds  and  fowls  should 
be  kept  out  of  the  room,  and  even  out  of  the  house.  The  patient  must 
have  plenty  of  fresh  air,  night  and  day.  In  winter  the  room  should 
be  heated  with  an  open  fire.  If  there  is  a  fireplace  have  a  fire  in  it,  even 
if  you  must  use  other  heat.  A  stove  makes  the  worst  kind  of  heat  for  a 
sick  room.    If  a  stove  must  be  used,  a  pan  or  kettle  of  water  should  be 


put  on  it.    The  bed  should  be  placed  near  the  center  of  the  room,  without 
letting  the  air  blow  directly  on  the.  patient. 

A  sheet  kept  wet  with  a  solution  of  carbolic  acid  (3^  ounces  of 
acid  to  one  gallon  of  water)  or  with  Standard  Disinfectant  No.  3,  recom- 
mended on  last  pages  of  this  circular,  ought  to  be  hung  over  the  door 
or  doors  communicating  with  the  sick  room.  This  will  prevent,  in  a 
great  measure,  the  virus  from  attaching  itself  to  clothing,  bedding,  fur- 
niture, etc.,  in  other  rooms,  and  will  obviate  the  necessity  of  a  thorough 
disinfection  of  the  rest  of  the  house  after  the  recovery  or  death  of  the 
patient.  Hang  this  sheet  on  the  opposite  side  from  which  the  door  opens. 
If  you  can  do  so,  employ  a  professional  nurse  for  the  patient. 
No  other  person  beside  the  nurse  and  necessary  attendants  should  be 
permitted  in  the  room,  and  they  should  take  special  precautions  not  to 
carry  the  infection.  Their  communication  with  the  rest  of  the  family 
should  be  as  restricted  as  possible.  Do  not  make  the  sick  room  a  place  of 
family  gathering. 

"Life  is  not  to  live  but  to  be  well." 

Neither  the  nuTse  nor  any  other  person  should  eat  or  drink  anything 
in  the  sick  room,  or  anything  which  has  been  there.  Food  which  the 
patient  has  left  should  be  burned  or  disinfected.  The  dishes  which  the 
patient  uses  should  not  be  used  by  others,  or  washed  with  other  dishes. 
They  should  be  washed  by  themselves  in  boiling  water. 

While  the  liberal  use  of  carbolic  acid  and  other  disinfectants  in 
the  room  is  recommended,  there  should  not  be  any  attempt  to  disinfect 
the  room,  when  occupied,  by  the  use  of  volatile  chemicals  agents,  such  as 
carbolic  acid,  chlorine,  etc.  It  cannot  be  done,  and  you  but  waste  your 
time  and  annoy  the  patient.  Neutralizing  odors  by  creating  others  does 
not  constitute  disinfection.  Fresh  air  and  absolute  cleanliness  are  all 
that  is  necessary.  Your  physician  may  recommend  the  distillation  of 
carbolic  acid  in  the  room  by  means  of  boiling  water,  to  prevent  the 
passage  of  diphtheritic  virus  in  the  air.  This  may  be  beneficial  and  can 
do  no  harm  unless  the  odor  worries  the  patient.  In  this,  as  in  all  other 
matters,  follow  your  physician's  advice.  He  desires  that  his  patient  shall 
recover,  and  recover  speedily. 

All  discharges  from  the  bowels  should  be  received  in  vessels  contain- 
ing a  quart  of  Standard  Disinfectant  No.  1*  (acid),  or  Standard  Dis- 


*See  pages  26  and  27  for  method  of  making  and  using  thie  Standard  Disinfectants. 


7 
infectant  No,  2.     Vomited  matter  and  discharges  from  the  lungs  and 
throat  should  be  received  in  vessels  containing  the  same  solution.   Have 
this  disinfectant  continually  on  hand  ready  for  use. 

Standard  iDisinfectant  No.  1  (acid)  or  Standard  Disinfectant  No.  2 
should  be  always  at  hand  for  washing  the  floor  or  bed  whenever  soiled  by 
discharges. 

The  discharges  from  the  throat,  mouth  and  nose  are  especially  dan- 
gerous and  must  be  cared  for  at  once.  It  is  well  to  prepare  a  number  of 
squares  of  old  soft  cloth  (old  sheets  or  pillow  cases)  to  receive  these 
discharges.  The  cloth  should  be  burned  as  soon  as  soiled.  If  there  is 
no  fire  in  the  sick  room,  it  is  convenient  to  have  a  small  tub,  containing 
the  disinfecting  solution,  to  receive  these  cloths  until  they  can  be  carried 
from  the  room  and  burned. 

All  knives,  forks,  spoons,  glasses,  cups  and  plates  used  by  the  patient 
must  be  disinfected  at  once  by  being  put  in  a  carbolic  acid  solution,  and 
later  boiled. 

A  wooden  pail  or  tub  containing  Standard  Disinfectant  No.  3  should 
be  kept  in  the  room,  and  all  blankets,  sheets,  towels,  pillow  slips  and 
other  articles  used  about  the  patient's  room  should  be  put  into  this  as 
soon  as  they  are  used  and  before  they  are  taken  from  the  room.  They 
should  be  allowed  to  soak  for  two  hours,  then  they  must  be  taken  out  and 
boiled  at  once.    Use  old  blankets  on  the  bed  and  burn  them  afterwards. 

Dust  and  dirt  must  be  removed  by  cloths  dampened  with  Standard 
Disinfectant  No.  3,  as  sweeping  and  dusting  are  objectionable.  These 
cloths  should  be  at  once  thrown  into  the  solution  or  into  the  fire. 

Books,  toys  and  articles  used  to  amuse  the  patient  when  convalescent 
are  best  disposed  of  by  burning  them  in  the  room.  Under  no  circumstances 
should  toys  be  borrowed  to  return  to  be  used  by  the  well.  Never  return 
a  hooJc  taken  from  a  public  library.    It  must  be  burned. 

"In  a  serious  trust  negligence  is  a  crime." 

No  person  from  a  house  where  diphtheria  is  should  go  into  public 
assemblies,  such  as  schools,  churches,  or  concerts,  or  anywhere  into  the 
presence  of  children.  No  person  in  said  house  should  leave  the  premises 
without  first  thoroughly  washing  his  hands,  face  and  hair,  and  brushing 
his  clothing  with  a  whisk  broom  wet  with  Standard  Disinfectant  No.  3. 
Children  who  have  had  diphtheria  should  not  be  allowed  to  go  to  school 


or  to  mingle  in  any  other  ^YaJ  with  the  public  while  they  remain 
infectious.  The  period  of  infection  varies  from  two  weeks  in  a  very 
mild  case  to  six  or  more  weeks  in  a  severe  case. 

A  person  who  has  had  an  attack  of  diphtheria  may  spread  the 
disease  for  six  weeks  from  the  beginning  of  the  sickness.  Such  person 
should  not  associate  with  others  nor  go  to  school  or  church,  or  to  any 
public  meeting,  until  the  throat  is  entirely  well,  and  the  sores  on  the 
lips  and  nose  are  healed.  Before  going  to  school  or  to  any  meeting,  the 
person  should  have  a  certificate  from  the  physician  or  health  officer, 
setting  forth  that  proper  precautions  have  been  taken  during  the  sick- 
ness, and  that  the  person  is  believed  to  be  free  from  danger  of  conveying 
the  disease  to  others. 

All  persons  recovering  from  diphtheria  are  dangerous.  Dangerous 
also,  and  but  in  a  slightly  less  degree,  are  all  individuals,  nurses,  attend- 
ants, parents,  brothers,  sisters,  other  relatives,  friends,  acquaintances, 
neighbors,  who  have  come  in  contact  with  the  patient,  or  who  have  been 
in  the  infected  rooms  prior  to  disinfection  of  the  same,  unless  their 
clothing  and  persons  have  been  disinfected. 

In  the  event  of  death,  the  body  must  be  wrapped  in  a  sheet  thoroughly 
soaked  in  Standard  Disinfectant  No.  2  and  then  placed  in  an  air-tight 
coffin.  Public  funerals  and  wakes  over  such  a  body  are  forbidden.  The 
coffin  must  not  'be  opened  nor  the  remains  again  exposed  under  any  pre- 
text whatsoever.  The  body  cannot  be  transported  by  rail  unless  pre- 
pared in  accordance  with  the  rules  of  this  Board  and  placed  in  an  air- 
tight metallic  casket.  jSTewspaper  notices  of  such  deaths  should  distinctly 
state  that  the  deceased  died  of  dijDhtheria. 

"To  the  living-  and  not  the  dead  is  your  duty  due." 


"There  is  no  relation  letween  the  severity  of  the  type  of  the  disease 
in  the  individual  who  is  the  source  &f't%e  infection  arid  in  the  individual 
who  .receives  it.  The  lightest  case  may  cause  the  most  malignant,  pro- 
vided the  susceptibility  or  predisposition  of  the  victim  who  receives  the 
infection  is  strong.  '  On  the  other  hand,  the  most  severe  or  malignant 
case  may  give  rise  to  a  very  mild  attach  in  a  person  whose  susceptibility 
or  predisposition,  is  slight.'' — Twentieth  Century  Practice  of  Medicine. 


9 


DISIISrFECTION  AFTER  RECOVERY  OR  DEATH. 

When  an  apartment  which  has  been  occupied  by  a  person  sich  luith  an 
infectious  disease  is  vacated,  it  shoidd  be  disinfected. 

The  object  of  disinfection  in  the  sick  room  is  the  destruction  of  infec- 
tious material  attached  to  surfaces,  or  deposited  as  dust  upon  window 
ledges,  in  crevices,  etc.  If  the  room  has  been  properly  cleansed  and 
ventilated  while  still  occupied  by  the  sick  person,  and  especially  if  it 
was  stripped  of  carpets  and  unnecessary  furniture  at  the  outset  of  his 
attack,  the  difficulties  of  disinfection  will  be  greatly  reduced. 

The  work  of  disinfection  should  begin  with  the  beginning  of  the 
treatment  of  cases,  and  should  continue  during  the  whole  course  of  the 
disease.  All  articles  of  bed  clothing  and  of  body  clothing  should  be 
disinfected  as  soon  as  they  are  removed  from  the  bed  or  from  the 
patient. 

During  the  entire  illness  the  privy  should  be  thoroughly  disinfected 
with  Standard  Disinfectant  No,  1,  four  or  five  gallons  of  which  should 
be  thrown  into  the  vault  every  day.  Instead  of  the  solution,  chloride 
of  lime  in  powder  can  be  used.  All  woodwork  in  the  vault  should  be 
soaked  with  the  solution  or  covered  with  powdered  lime.  Water  closets 
and  sinks  should  be  disinfected  daily  by  pouring  a  quart  or  more  of  the 
solution  of  chloride  of  lime  or  carbolic  acid  into  the  pipes.  The  pipes 
should  be  freely  flushed  in  order  to  avoid  injury. 

After  the  patient  has  been  removed  from  the  room,  it  should  be 
thoroughly  fumigated,  with  all  its  contents,  by  burning  sulphur  or 
evaporating  formaldehyde,  and  by  a  thorough  cleansing  with  a  dis- 
infectant solution. 

"Whatever  is  Worth  Doing  is  Worth  Doing  Well." 
The  following  mode  of  procedure*  will  be  found  easy  of  application, 
economical  and  effective : 

(a)  Have  all  windows  and  doors  (except  doors  of  egress),  tightly 
closed.  Securely  paste  strips  of  paper  over  keyholes,  over  cracks,  above, 
beneath  and  at  sides  of  windows  and  doors,  over  stove  holes  and  all 
openings  in  walls,  ceiling  and  floor.  If  opening  be  large,  paste  several 
thicknesses  of  paper  over  opening.  Carefully  stop  up  the  fireplace 
if  there  be  one.    There  must  be  no  opening  through  which  gas  can  escape. 

*See  pages  22  and  23  for  method  of  disinfection  with  formaldehyde. 


10 

(b)  All  articles  in  the  room  that  cannot  be  washed  must  be 
spread  out  on  chairs  or  racks.  Clothing,  bed  covers,  etc.,  should  be 
hung  on  lines  stretched  across  the  room.  Mattresses  should  be  opened 
and  set  on  edge;  window  shades  and  curtains  spread  out  at  full  length. 
If  there  is  a  trunk  or  chest  in  the  room,  open  it,  but  let  nothing  stay 
in  it.  Open  the  pillows  so  that  the  sulphur  fumes  can  reach  th.e 
feathers.  Do  not  pile  articles  together. 
.J  (c)     Use  three  pounds  of  powdered  sulphur  for  every  1,000  cubic 

%■        feet  in  the  room.    A  room  ten  feet  long,  ten  feet  wide  and  ten  feet  high 
has  1,000  cubic  feet.    For  a  closet,  use  two  pounds  of  sulphur. 

(d)  Burn  the  sulphur  in  an  iron  pot  or  deep  pan.  Let  the  pot  or 
pan  stand  in  a  large  vessel  containing  water,  which  vessel  should  be 

' ;       placed  on  a  table,  not  on  the  floor.     For  example,  take   a  common 

■'       washtub,  lay  in  it  three  or  four  bricks,  pour  in  water  to  the  level  of 

^  '    top  of  bricks,  put  the  pot  or  pan  containing  the  required  amount  of 

■;    sulphur  on  the  bricks,  place  the  washtub  and  contents  on  a  table.     The 

I     disinfecting  ^'apparatus"  is  then  in  working  order. 

.Moisten  the  sulphur  with  alcohol  and  ignite.     When  the  sulphur 
.  i'  begins  to  burn,  leave  the  room,  close  the  door  of  egress,  and  carefully 
•     1  paste  strips  of  paper  over  the  keyhole  and  all  openings  above,  beneath 
and  at  side  of  door.    Keep  the  room  closed  for  ten  hours  at  least. 

Sulphur  candles  can  be  used  instead  of  crude  sulphur,  but  care  must 
be  taken  to  use  sufRcifent  candles.  The  average  candle  on  the  market 
: contains  one  pound  of  sulphur.  Three  of  these  will  be  required  in  the 
disinfection  of  a  small  room,  10x10x10.  Do  not  use  a  less  number,  no 
matter  what  directions  may  accompany  the  candle.  The  water- jacketed 
candle  is  preferable.  Partly  fill  tin  around  candle  with  water  and  place 
candle  in  a  pan  on  the  table,  not  on  the  floor.  Let  one-half  pint  of  water 
be  vaporized  with  each  candle.  In  the  absence  of  moisture,  the  fumes 
of  sulphur  have  no  disinfecting  power. 

(e)  After  the  apartments  are  opened,  take  out  all  articles  and  place 
them  in  the  sunshine.  Carpets  should  be  well  beaten  and  exposed  to 
tlie  sun. 

(f )  All  surfaces  in  the  room  should  then  be  thoroughly  washed  with 
Standard  Disinfectant  No.  3.  Walls  and  ceilings,  if  plastered,  should 
subsequently  be  washed  with  lime.  W^ash  well  all  out-of-the-way  places, 
window   ledges,   mouldings,    etc.      Floors,    particularly  should    receive 


11 

careful  treatment,  and  the  solution  should  wet  the  dust  and  dirt  in  the 
cracks. 

"Lingering  labor  often  comes  to  naught." 

(g)  After  washing,  ventilate  the  rooms,  if  possible,  for  several 
hours. 

(h)     It  is  safer  to  burn  mattresses  and  pillows. 

(i)  It  is  likewise  safer  to  burn  all  books,  toys  and  articles  of 
small  value  which  have  been  handled  by  the  patient.  Burn  what 
you  cannot  boil.  Books  which  have  not  been  handled  by  the  patient 
can  be  saved.  Lay  them  on  edge  on  a  table  with  leaves  open,  in  a  room 
while  the  sulphur  is  burning. 

Unless  all  precautions  recommended  have  been  taken  in  the  sick 
room,  the  entire  house  must  be  disinfected  in  the  manner  directed  for 
the  sick  room;  otherwise  a  thorough  "cleaning  house"  exposure  of  all 
articles  to  air  and  sunshine,  the  beating  of  carpets,  etc.,  will  be  all  that 
is  necessary.  In  case  the  entire  house  is  disinfected,  take  out  before 
exposure  to  sulphur,  any  pianos,  sewing  machines,  lace  curtains,  fine 
paintings  or  draperies,  and  expose  them  to  the  sun.  Sulphur  fumes 
injure  these  articles.    Formaldehyde  does  not. 

The  infection  must  not  remain  in  the  house.  It  is  a  menace  to  the 
lives  and  health  of  the  patient,  the  children,  if  any,  of  the  family,  and 
your  neighbor's  children. 

There  is  one  serious  objection  to  the  use  of  sulphur,  and  this  must 
be  fully  understood.  The  fumes  of  sulphur  have  a  destructive  action  on 
fabrics  of  wool,  silk,  cotton  and  linen,  on  tapestries  and  draperies,  and 
exercise  an  injurious  influence  on  brass,  copper,  steel  and  gilt  work. 
Colored  fabrics  are  frequently  changed  in  appearance  and  the  strength 
impaired.  Curtains  and  all  articles  of  cotton  or  linen  can  be  effectually 
disinfected  by  boiling  or  soaking  them  in  Standard  Disinfectant  No.  3 
for  several  hours,  and  portable  articles  of  brass,  copper,  steel  and  gilt 
work  by  washing  with  a  strong  solution  of  carbolic  acid  (Standard  Dis- 
infectant No.  1). 

Formaldehyde  (the  40  per  cent  solution)  may  be  used  instead  of 
sulphur  if  desired.    See  pages  22  and  23  for  method  of  application. 

"Whatever  thou  takest  in  hand  remember  the  end,  and  thou 
shalt  never  do  amiss. ' ' 


PUBLIC  HEALTH  LAWS  OF  ILLINOIS. 


EXTEACTS  FEOM  THE  EEVISED  STATUTES. 


POWERS  AND  AUTHOEITT  OF  THE  STATE  BOARD  OP  HEALTH. 

■  (Extract.) 

The  State  Board  of  Health  shall  have  the  general  supervision  of 
the  interests  of  the  health  and  life  of  the  citizen  of  the  state.  They 
shall  have  charge  of  all  matters  pertaining  to  quarantine ;  and  shall  have 
authoritjr  to  make  such  rules  and  regulations,  and  such  sanitary  investi- 
gations, as  they  may  from  time  to  time  deem  necessary  for  the  preserva- 
tion  or  improvement  of  public  health;  and  it  shall  be  the  duty  of  all 
police  officers,  sheriffs,  constables,  and  all  other  officers  and  employes  of 
the  state,  to  enforce  such  rules  and  regulations,  so  far  as  the  efficiency 
and  success  of  the  Board  may  depend  upon  their  official  co-operation. 
[Revised  Statutes,  Chap.  126a,  Sec.  2.'] 

POWERS    OP    CITY    COUNCILS    IN    CITIES   AND   PRESIDENTS    AND    BOARDS    OF 
TRUSTEES  IN  VILLAGES  INCORPORATED  UNDER  THE  GENERAL  LAW. 

[Revised  Statutes,  Chap.  2J/.,  Sec.  62.1 
(Extracts.) 

Seventy-fifth — To  declare  what  shall  be  a  nuisance,  and  to  abate  the 
same;  and  to  impose  fines  upon  parties  who  may  create,  continue  or 
suffer  nuisances  to  exist. 

Seventy-sixth — To  appoint  a  board  of  health,  and  prescribe  its  powers 
and  duties. 

Seventy-eighth — To  do  all  acts,  make  all  regulations  which  may  be 
necessary  or  expedient  for  the  promotion  of  health  or  the  suppression  of 
disease. 


13 

Eighty-first — To  direct  the  location  and  regulate  the  management 
and  construction  of  packing  houses^  renderies,  tallow  chandleries,  bone 
factories,  soap  factories  and  tanneries,  within  the  limits  of  the  city  or 
village,  and  within  the  distance  of  one  mile  without  the  city  or  village 
limits. 

Eighty-third — To  prohibit  any  offensive  or  unwholesome  business  or 
establishment  within  or  within  one  mile  of  the  limits  of  the  corporation. 

Eighty-fourth — To  compel  the  owner  of  any  grocery,  cellar,  soap  or 
tallow  chandlery,  stable,  pig  sty,  priv)^,  sewer  or  other  unwholesome 
or  nauseous  house  or  place,  to  cleanse,  abate,  or  remove  the  same,  and 
to  regulate  the  location  thereof. 

Ninety-sixth — To  pass  all  ordinances,  rules,  and  make  all  regulations, 
proper  or  necessary,  to  carry  into  effect  the  powers  granted  to  cities  or 
villages,  with  such  fines  or  penalties  as  the  city  council  or  board-  of 
trustees  shall  deem  proper:  Provided,  no  fine  or  penalty  shall  exceed 
$200,  and  no  imprisonment  shall  exceed  six  months  for  one  offense. 

Territorial  Jurisdiction — The  city  council  and  board  of  trustees  shall 
also  have  jurisdiction  in  and  over  all  places  within  one-half  mile  of  the 
city  or  village  limits,  for  the  purpose  of  enforcing  health  and  quarantine 
ordinances  and  regulations  thereof.  [Revised  Statutes,  Chap.  2Jlf,  Sec.  ^^.] 


POWEES    OF    COUNTY    AND    TOWNSHIP    BOARDS    OF    HEALTH. 


[Act  approved  May  10,  in  force  July  1,  1901.    Amended  hy  act  in  force 

July  1,  1903.'] 

(Extracts.) 

Section  1.  The  hoard  of  county  cammissioners  in  counties  not  under 
township  organization,  and  the  supervisor,  assessor  and  to^ivn  clerh  of 
every  town  in  counties  under  township  organization,  shall  constitute  a 
board  of  health,  and  on  the  breaking  out  of  any  contagious  or  .infectious 
disease  in  their  county  or  town,  or  in  the  immediate  vicinity  thereof,  it 
shall  be  their  duty  to  make  and  enforce  such  rules  and  regulations  tend- 
ing to  check  the  spread  of  the  disease  within  the  limits  of  such  county 
or  town  as  may  be  necessary ;  and  for  this  purpose  they  shall  have  power 
to  quarantine  any  house  or  houses,  or  place  where  any  infected  person 
may  be,  and  cause  notices  of  warning  to  be  put  thereon,  and  to  require 
the  disinfection  of  the  house  or  place:  Provided,  that  nothing  in  this 
act  shall  apply  to  any  territory  lying  within  the  corporate  limits  of  any 
incorporated  city  or  village:  Provided,  further,  that  in  case  the  board 
of  health  of  any  county  not  under  township  organization,  or  of  any 
toAvnship  in  counties  under  township  organization  shall  fail,  refuse  or 


14 

neglect  to  promptly  take  the  necessary  measures  to  preserve  the  public 
healthy  or  in  case  any  such  board  of  health  shall  refuse  or  neglect  to 
carry  out  the  rules  and  regulations  of  the  State  Board  of  Health,  that 
thereupon  the  State  Board  of  Health  may  discharge  such  duties  and 
collect  from  the  county  or  township,  as  the  case  may  be,  the  reasonable 
costs,  charges  and  expenses  incurred  thereby, 

§  2.     The  said  board  of  health  shall  have  the  following  powers : 

First — To  do  all  acts,  make  all  regulations  which  may  be  necessary 
or  expedient  for  the  promotion  of  health  or  the  suppression  of  disease. 

Second — To  appoint  physicians  as  health  officers  and  prescribe  their 
duties. 

Third — To  incur  the  expenses  necessary  for  the  performance  of  the 
duties  and  powers  enjoined  npon  the  board. 

Fourth — To  provide  gratuitous  vaccination  and  disinfection. 

Fifth — To  require  reports  of  dangerously  communicable  diseases. 

§  3.  Any  person  who  shall  violate,  or  refuse  to  obey,  any  rule  or 
regulation  of  the  said  board  of  health,  shall  be  liable  to  a  fine  not 
exceeding  $200  for  each  offense,  or  imprisonment  in  the  county  jail  not 
to  exceed  six  months,  or  both,  in  the  discretion  of  the  court. 

All  fines  collected  under  the  provisions  of  this  act  shall  be  paid  into 
the  county  treasury  of  the  county  in  which  the  suit  is  brought,  to  be  used 
for  county  purposes,  and  it  shall  be  the  duty  of  the  State's  attorney  in 
the  respective  counties  to  prosecute  all  persons  violating,  or  refusing  to 
obey,  the  rules  of  said  local  boards  of  health. 


"In  nearly  all  health  and  quarantine  laws  some  are  put  to  incon- 
venience and  annoyance  and  many,  to  a  certain  extent,  are  deprived 
of  their  liberty  and  freedom  of  action.  But,  if  the  public  necessity 
requires  it,  the  convenience  or  even  liberty  of  the  individual  citizen 
must  give  way  for  the  welfare  of  the  greater  number.  *  *  *  The 
good  of  the  many  must  be  preferred  to  the  convenience  or  supposed 
welfare  of  the  few." — Decision  Appellate  Court  of  Illinois,  Second 
district,  Lawbaugh  vs.  Board  of  Education,  66  111.  App.,  159. 


15 


RULES  AND  REGULATIONS  FOR  PHYSICIANS 
AND  HEALTH  AUTHORITIES. 


EECOMMENDATIONS  TO  PHYSICIANS. 

Use  Antitoxin  Early. 

As  in  the  diagnosis  of  all  cases  of  suspected  communicable  diseases, 
great  care  should  be  exercised  in  the  diagnosis  of  suspected  diphtheria. 
Osier  says,  "When  a  bacteriological  examination  cannot  be  made,  the 
practitioner  must  regard  as  suspicious  all  forms  of  throat  affections  in 
children  and  carry  out  measures  of  isolation  and  disinfection.  In  this 
way  alone  can  serious  errors  be  avoided.'^  This  mode  of  procedure 
however,  is  more  applicable  to  hospital  than  to  private  practice. 

It  is  wise  for  the  physician  to  take  into  consideration  the  fact  of 
exposure  or  non-exposure  to  the  disease,  and  the  prevalence  or  absence  of 
the  disease  in  the  vicinity.  If  in  any  case  exposure  to  diphtheria  is 
known  to  have  occurred,  even  a  slightly  suspicious  sore  throat  should  be 
regarded  as  probably  a  mild  diphtheria.  If  on  the  other  hand,  no  cases 
of  diphtheria  have  been  known  to  exist  in  the  neighborhood,  the  ailment 
should  not  be  termed  diphtheria  unless  clinical  characteristics  are 
obvious. 

The  most  certain  evidence  of  diphtheria  is  the  finding  of  Klebs- 
Loeffler  bacillus  in  the  membrane,  but  the  absence  of  diphtheria  bacilli 
in  the  first  culture,  especially  in  cases  where  the  disease  is  confined  to 
the  larynx  or  bronchi,  must  not  be  accepted  as  conclusive  evidence  of 
the  non-existence  of  diphtheria,  particularly  if  there  be  a  striking  dis- 
crepancy between  the  clinical  and  the  bacteriological  diagnosis.  The 
bacilli  may  be  found  abundantly  in  the  second  culture. 


16        ■ 

g^^Eemember  that  the  Laboratory  of  the  State  Board  of  Health 
at  Springfield  is  ready,,  at  all  times,  to  afford  aid  to  physicians  in 
establishing  diagnoses.  Bacteriological  examinations  are  made  free  of 
cost. 

When  the  facilities  for  making  a  bacteriological  examination  are  not 
at  hand,  or  it  is  not  practicable  to  send  a  specimen  of  the  membrane  to 
the  State  Board  of  Health,  dependence  must  be  placed  upon  the  clinical 
symptoms.  There  are  but  two  conditions  with  which  diphtheria  is  liable 
to  be  confounded,  viz.,  the  different  forms  of  diphtheroid  faucitis,  includ- 
ing follicular  tonsilitis,  and  scarlatina.  Scarlatina  and  diphtheria  may 
co-exist,  but  such  cases  are  exceedingly  rare.  Scarlatina  leads  more  or 
less  to  temporary  damage  to  the  mucous  membrane  of  the  throat,  and  in 
this  manner  predisposes  to  the  reception  of  the  diphtheria  poison,  causing 
a  series  of  diphtheria  cases  to-  follow  after  a  series  of  scarlatina  cases. 
The  diagnosis  of  a  typical  pharyngeal  diphtheria  (the  usual  form 
prevailing)  will  not  ordinarily  be  found  difficult  if  careful  attention  be 
given  to  the  history  of  the  case,  the  constitutional  disturbances,  the 
appearance  and  characteristics  of  the  membrane  and  exudates  and  the 
occurrence  of  albuminuria.  To  the  seat  of  the  membrane,  especial 
attention  must  always  be  given,  as  to  the  firm  incorporation,  in  diph- 
theria, of  the  exudate  with  the  underl3dng  mucoiTS  membrane. 

Memlranous  Croup. — Unless  it  has  been  determined  by  bacterio- 
logical tests  that  the  disease  is  non-diphtheritic,  all  cases  of  so-called 
membranous  croup  should,  in  the  interest  of  the  public  health,  be 
considered  diphtheria,  for  sanitary  purposes  at  least,  and  should  be  so 
reported.  It  is  well  known  that  with  a  very  large  proportion  of  all  cases 
of  membranous  larjmgitis,  the  Klebs-Loeffler  bacillus  is  associated, 
whether  an  exudate  is  present  in  the  phar}Tix  or  not,  and  it  is  practically 
impossible  to  make  a  positive  diagnosis  without  a  bacteriological  test. 
In  view  of  these  facts  the  public  safety  demands  that  the  same  pre- 
ventive measures  be  applied  to  cases  of  membranous  croup  as  to  cases  of 
recognized  diphtheria.  It  must  be  remembered  that  in  laryngeal  diph- 
theria, i.  e.,  membranous  croup,  the  diphtheria  bacillus  nearly  always 
produces  its  influence  fijst  on  the  mucous  membrane  of  the  larynx,  and 
in  these  cases  the  mucous  membrane  of  the  nose  and  pharjTix  may  never 
show  any  evidence  of  membrane. 

Use  Antitoxin  Early. 


17 

On  being  satisfied  that  diphtheria  exists  in  a  family,  the  attending 
physicians  should  direct  the  observance  of  all  precautions  necessary  to 
prevent  the  further  spread  of  the  disease,  and  should  AT  ONCE  EE- 
POET  the  case  or  cases  to  the  local  board  of  health,  if  there  be  one,  if 
not,  to  the  legally  constituted  health  authorities. 

The  physician  should  avoid  carrying  infection.  A  very  leading  man- 
ner of  the  conveyance  of  the  bacillus  is  by  fomites.  The  contagion 
adheres  tenaciously  to  a  great  variety  of  objects,  and  has  been  trans- 
ferred in  clothing  over  great  distances,  giving  rise  to  the  disease  long 
after.  The  physician  should  thoroughly  disinfect  all  instru.ments  used 
on  a  patient  and  should,  especially  after  close  contact  with  the  patient, 
wash  his  hair  and  all  exposed  cutaneous  surfaces  with  a  germicidal 
solution  and  thoroughly  brush  his  clothing  with  a  whisk  broom  wet  with 
the  solution. 

On  the  recovery  of  the  patient  the  attending  physician  should  notify 
the  local  health  authorities,  in  order  that  the  quarantine  restrictions 
can  be  removed.  The  physician  should  also  impress  upon  the  local  health 
authorities  the  absolute  necessity  for  a  thorough  disinfection  of  the 
infected  room  or  rooms,  if  he  has  reason  to  believe  that  this  important 
feature  of  preventive  medicine  will  be  overlooked. 

Use  Antitoxin  Early. 

DUTIES   OF  LOCAL  HEALTH  AUTHORITIES. 

Isolate,  Quarantine,  Disinfect. 

Whenever  a  case  of  diphtheria  or  membranous  croup  is  reported,  the 
local  health  officer,  if  there  be  one,  or  a  physician  appointed  by  the 
city,  village  or  town  authorities;  should  visit  the  premises  and  secure 
prompt  compliance  with  the  precautions  herein  enjoined.  Every  infected 
house  should  be  properly  placarded,  and  all  children  therein  confined  to 
the  immediate -premises  during  the  prevalence  of  the  disease,  and  steps 
should  be  taken  to  prevent  all  unauthorized  persons,  especially  children 
from  visiting  the  premises.  Adults  from  the  infected  house  should  be 
prohibited  from  mingling  unnecessarily  with  other  people,  above  all 
with  children,  and  should  be  required  to  disinfect  their  clothing  before 
going  out  of  the  house. 

Prompt  reports  of  the  existence  of  diphtheria  in  a  family  should  be 
furnished  to  all  public  libraries,  and  care  should  be  taken  that  no  book 
from  the  infected  premises  be  returned  to  the  libraries. 


18 

It  is  not  considered  necessary  to  close  the  schools  during  the  preva- 
lence of  diphtheria  in  a  community  unless  it  prevails  in  epidemic  form, 
but  all  schools  in  the  neighborhood  should  be  notified  of  the  existence 
of  the  disease,  and  should  any  children  affected  with  diphtheria  have 
attended  school,  the  school  should  be  promptly  closed  until  disinfected. 

It  is  imperative  that  similar  notice  be  sent  also  to  the  superintendents 
of  all  Sunday  schools,  or  to  the  pastors  of  the  churches,  for  there  is  no 
question  but  that  the  liability  of  the  dissemination  of  contagious  diseases 
is  greater  in  Sunday  schools,  which  are  used  but  once  a  week,  than  in 
public  schools,  which  are  cleaned  and  ventilated  daily.  As  a  further 
precautionary  measure  the  local  health  authorities  should  see  that  rooms 
used  for  Sunday  school  purposes  be  kept  in  a  sanitary  condition  and 
freely  ventilated  at  intervals  during  the  week. 

Overdo  rather  than  underdo! 

When  should  the  patient  be  released  from  quarantine?  The  time  is 
variable,  depending  entirely  upon  the  character  of.  the  disease,  and  the 
presence  or  absence  of  complications. 

Health  officers  will  ordinarily  be  justified  in  raising  the  quarantine 
whenever  the  attending  physician  certifies  that  the  patient  has  entirely 
recovered  from  diphtheria;  that  there  is  no  danger  of  spread  of  the 
infection  from  the  patient.  As  a  rule,  however,  the  minimum  length 
of  quarantine  should  be  two  weeks.  In  very  mild  cases,  and  particularly 
when  antitoxin  has  been  administered,  the  quarantine  may  be  raised 
within  ten  days,  provided  the  physician  furnishes  the  certificate  required, 
and  especially  if  a  bacteriological  examination  of  the  throat  shows  no 
evidence  of  the  presence  of  the  bacilli  of  diphtheria. 

The  quarantine  should  not  be  raised,  however,  until  the  infected 
room,  and  if  necessary  the  entire  house,  has  been  properly  disinfected. 

On  receiving  a  certificate  from  the  attending  physician  that  the 
patient  has  entirely  recovered,  and  that  no  further  quarantine  is  neces- 
sary, the  local  health  officer  should  see  that  the  infected  room  and 
premises,  if  thought  necessary,  with  contents,  be  DISIISTFECTED  as 
directed  herein.  To  be  effective,  the  disinfection  must  be  thorough. 
"There  can  be  no  partial  disinfection  of  infectious  material;  either 
its  infectious  power  is  destroyed  or  it  is  not.  In  the  latter 
case  there  is  a  failure  to  disinfect."  Deodorants  merely  remove 
offensive  odors,  and  may  not  have  any  disinfecting  power  whatever.     A 


19 

failure  to  properly  disinfect  apartments  often  leads  to  the  recurrence  of 
the  disease. 

The  bacilli  of  diphtheria  will  live  on  infected  substances  for  weeks. 
They  have  been  known  to  live  for  several  months  on  children's  playthings 
which  have  been  put  away. 

In  the  disinfection  of  school  rooms  the  burning  of  sulphur  is  usually 
advisable.     This  fumigation  should   always   be   followed  by   thorough 
airing  for  several  hours.    The  floors  and  all  furniture  should  be  washed 
with  a  germicidal  solution,  preferably  Standard  Disinfectant  No.  3; 
Disinfect. 

Local  boards  of  health  and  health  officers  should  guard  against  the 
introduction  or  spread  of  contagious  disease  by  the  exercise  of  proper 
and  vigilant  inspection  and  control  of  all  persons  and  things  coming 
within  their  Jurisdiction.  They  should  require  prompt  reports  of  all 
infectious  and  contagious  diseases  and  the  isolation  of  all  persons  and 
'things  infected  with  or  exposed  to  infectious  or  contagious  diseases,  and 
should  placard  and  disinfect  infected  premises,  close  schools  and  assume 
charge  of  funerals,  if  necessary.  They  should  also  cause  the  arrest  and 
imprisonment  of  all  persons  violating  their  orders.  The  authorities  may, 
in  general,  take  any  measure  of  precaution,  however  stringent,  which 
they  may  deem  necessary  or  prudent  in  the  interest  of  the  health  of  the 
inhabitants.    "The  health  of  the  people  is  the  supreme  law." 

There  is  no  more  liberal  law  or  charter  in  existence  than  is  given 
to  the  councils  of  cities  and  the  trustees  of  villages  by  section  62,  chap- 
ter 24,  of  the  Eevised  Statutes,  for  the  almost  absolute  and  unrestrained 
control  of  the  agencies  affecting  the  public  health.  Concerning  the 
force  and  effect  of  such,  the  Supreme  Court  of  Illinois,  in  the  case  of 
Mason  et  al.  vs.  The  City  of  Shawneetown,  77  111.  533,  says:  "Where  an 
incorporated  town  or  city  has  been  invested  with  power  to  pass  an  ordi- 
nance, by  the  Legislature,  for  the  government  or  welfare  of  the  munici- 
pality, an  ordinance  enacted  by  the  legislative  branch  of  the  corporation 
in  pursuance  of  an  act  creating  the  corporation,  has  the  force  and  effect 
of  a  law  passed  by  the  legislature,  and  cannot  be  regarded  otherwise  than 
as  a  law  of  and  within  the  corporation.  An  ordinance  is  the  law  of  the 
inhabitants  of  the  municipality." 
Disinfect. 


20 

DISIXFECTIOX. 

"Do  it  now,"  and  "Do  it  right." 

The  thorough  disinfection  of  infected  apartments  or  dwelling  is  as 
important  as  the  maintenance  of  an  efficient  quarantine  during  the  prev- 
alence of  the  disease.  Hence,  no  agent  should  be  employed  in  the  effort 
to  destroy  the  germs  of  disease,  upon  the  efficiency  of  which,  under  all 
circumstances,  there  rests  any  doubt  or  uncertainty.  The  use  of  a  worth- 
less disinfectant  or  the  misuse  of  a  valuable  one  not  only  involves  a  waste 
of  time  and  material,  but  jeopardizes  the  health  of  the  community. 

Disinfection  of  an  infected  apartment  can  be  successfully  performed 
by  thoroughly  wetting  the  floors,  ceilings,  walls  and  all  exposed  surfaces 
with  an  efficient  germicidal  solution.  This  method,  however,  is  not  appli- 
cable to  the  contents  of  the  apartment.  For  these  fire  is  the  most 
reliable  disinfectant,  yet,  as  other  reliable  disinfectants  are  available, 
there  is  little  justification  for  the  burning  of  any  article  of  value,  except, 
for  instance,  books  or  mattresses  or  pillows,  which  cannot  be  successfully 
disinfected  except  by  steam. 

All  infected  apartments,  with  contents,  should  be  disinfected  by  an 
efficient  aerial  germicide,  and  this  fumigation  should  be  followed  by  a 
thorough  washing  of  the  walls,  ceilings,  floors  and  exposed  surfaces' 
of  the  room  with  a  reliable  disinfecting  solution. 

Fumigation  by  burning  sulphur  has  for  many  years  been  a  favorite 
method  of  aerial  disinfection.  As  stated  in  the  recently  revised  Prize 
Essay  of  the  American  Public  Health  Association,  on  "Disinfectant  and 
Individual  Prophylaxis  Against  Infectious  Diseases,"  by  Surgeon  General 
George  M.  Sternberg,  H.  S..  A.,  "the  experience  of  sanitarians  is  in  favor 
of  its  use  in  yellow  fever,  small-pox,  scarlet  fever,  diphtheria  and  other 
diseases  in  which  there  is  reason  to  believe  that  the  infectious  material 
does  not  contain  spores."  In  the  majority  of  the  infectious  diseases  the 
specific  germ  does  not  form  resistant  spores,  hence  sulphur  dioxide 
would  seem  to  be  a  reliable  aerial  disinfectant.  It  must  be  remembered 
also  that  some  authorities  do  not  subscribe  to  the  statement  that  sulphur 
is  powerless  to  destroy  pathogenic  organisms  containing  spores. 

Admitting  the  impotency  of  the  fumes  of  sulphur  dioxide  under 
certain  conditions,  and  the  fact  that  they  may  not  kill  the  spores  of 
anthrax  or  other  bacilli,  "there  is  no  reason,"  as  stated  by  Dr.  Sternberg, 
"for  rejecting  an  agent  which  has  been  demonstrated  by  experience  to 


'21 

be  one  of  great  value^  which  has  been  proved  by  laboratory  experiments 
to  be  fatal  to  pathogenic  organism  in  the  absence  of  spore  and  to  destroy 
the  infecting  power  of  vaccine  virus," 

Sulphur  will  be  found  a  thoroughly  reliable  gaseous  disinfectant* 
of  considerable  penetrating  power  if  it  is  intelligently  employed.  To 
obtain  satisfactory  results,  the  following  essentials  of  successful  disin- 
fection, established  by  repeated  experiments,  must  be  observed :  (a)  The 
infected  room,  or  rooms,  must  be  thoroughly  closed,  every  crack  and 
crevice  sealed,  (b)  Sufficient  sulphur  must  be  used,  (c)  There  must  be 
ample  moisture  in  the  room,  (d)  The  time  of  exposure  must  be  suffi- 
cient, ten  hours  the  minimum. 

In  the  disinfection  of  stores,  halls,  school  houses  and  apartments  or 
dwellings  in  which  there  are  no  articles  to  be  injuriously  affected  by  the 
gas,  sulphur  is  an  ideal  disinfectant.  Its  mode  of  application  is  simple 
(the  simpler  the  mode  of  application,  the  better);  it  is  cheap;  the 
material  is  accessible  everywhere,  and,  finally,  the  most  important  of  all, 
the  action  will  be  invariably  found  effective  when  the  sulphur  is  properly 
used. 

During  recent  years,  formaldehyde  gas  has,  to  a  very  considerable 
extent,  taken  the  place  of  sulphur  dioxide  as  a  gaseous  disinfectant. 
Various  methods  for  the  use  of  formaldehyde  have  been  devised — all 
requiring  apparatus  more  or  less  expensive  and  complicated — all  exploited 
with  extravagant  claims  of  merit  and  infallibility,  l^one  of  these,  how- 
ever, has  proven  worthy  of  the  claims  made  for  it,  while  many  have 
been  entirely  worthless.  The  fact  that  the  vast  majority  of  devices,  at 
one  time  exploited  and  enjoying  wide  popularity,  and  widely  purchased 
fey  confiding  health  officers,  have  been  eventually  relegated  to  the  junk 
heap,  indicates  clearly  the  failure  of  former  methods  of  formaldehyde 
disinfection  to  meet  the  requirements  upon  them. 

"Any  man  may  make  a  mistake,  but  none  but  a  fool  will  con- 
tinue in  it." 

Almost  continuously  since  1897  the  State  Board  of  Health  has  experi- 
m.ented  with  and  investigated  the  merits  of  formaldehyde.  Every  device 
and  every  apparatus  coming  to  the  attention  of  the  Board  has  been 
fairly  and  thoroughly  tested.  '  In  view  of  the  results  obtained  with  all. 


*See  page  9  for  simple  method  of  application. 


22 

the  State  Board  of  Health  has  been  unable  to  recommend  formaldehyde 
disinfection  in  the  past,  and  is  only  able  to  recommend  it  now  when 
employed  with  one  method  in  a  proper  apparatus. 

The  method  now  unreservedly  recommended  by  the  Board  con- 
sists merely  in  pouring  formaldehyde  solution  over  crystals  of  potassium 
permanganate.  This  method  primarily  offers  the  advantage  of  absolute 
simplicity  in  operation,  requiring  no  special  apparatus  and  no  fire. 
In  addition  to  this,  exhaustive  experimental  work  has  demonstrated  that,  ■ 
in  practical  disinfection,  the  method  is  unusually  efficient,  regardless 
of  the  conditions  of  humidit}',  temperatures  and  other  factors  which 
materially  affect  other  methods  of  the  use  of  formaldehyde. 

The  only  apparatus  required  is  a  large  open  vessel,  protected  by 
some  non-conductive  material  to  prevent  the  loss  of  heat  from  within. 
An  ordinary  milk-pail,  set  into  a  pulp  or  wooden  bucket,  will  answer 
every  purpose,  although  a  special  container,  devised  for  physicians  and 
health  officers,  will  be  found  of  considerable  advantage.  This  container 
or  generator  consists  of  a  simply  constructed  tin  can  with  broad,  flaring 
top.  Its  full  height  is  15^  inches,  the  height  from  the  bottom  to  the 
flaring  top  being  about  8  inches.  The  lower  or  round  section  is  10  inches 
in  diameter,  while  the  flaring  top  is  17^  inches  in  diameter  at  its  top. 
The  container  is  made  of  a  good  quality  of  bright  tin,  is  supplied  with  a 
double  bottom  with  ^  inch  air  space  between  the  two  layers,  and  is 
entirely  covered  on  sides  and  bottom  with  asbestos  paper.  The  asbestos 
paper  and  double  bottom  serve  effectively  to  retain  the  heat  which  is 
generated  by  the  vigorous  chemical  reaction  occurring  within,  and 
which  is  essential  to  the  complete  production  and  liberation  of  the  gas. 
This  special  container  can  be  made  by  any  tinner  of  ordinary  intelli- 
gence and  costs  but  a  few  dollars.    It  is  illustrated  on  page  24. 

With  the  room  sealed,  as  described  on  page  9,  and,  as  is  essential 
to  any  form  of  aerial  disinfection,  the  crystals  of  potassium  perman- 
ganate (6f  ounces  to  each  1,000  cubic  feet  of  room  space,  or  10  ounces 
when  the  temperature  is  below  60°  F.)  are  placed  in  the  container. 
Over  this  salt  is  poured  "formalin,"  or  the  40  per  cent  aqueous  solution 
of  formaldehyde  (16  ounces  to  every  1,000  cubic  feet  of  room  space, 
or  24  ounces  when  the  temperature  is  below  60°  F.).  The  formalde- 
hyde gas  is  promptly  liberated  by  the  vigorous  chemical  reaction  of  the 
formalin  and  potassic  salt  and  rises  from  the  generator  in  immense 


23 

volume  in  the  form  of  an  inverted  cone.  It  is  consequently  necessary 
that  all  preparations  be  made  in  advance,  and  that  the  operator  leave 
the  room  at  once  on  the  combination  of  the  two  chemicals. 

The  door  or  window  of  exit  will  be  promptly  closed  and  sealed,  and 
the  room  left  closed  for  at  least  four  hours. 

As  in  all  methods  of  disinfection,  success  largely  depends  upon 
the  care  which  is  exercised  and  the  attention  which  is  given  to  every 
detail.  Simple  as  the  method  is,  neglect  of  any  of  the  following  points 
may  result  in  complete  failure  : 

The  sick  room  is  not  the  place  for  experiments. 

1.  The  room  should  be  sealed  and  prepared  as  described  on  page  9. 

2.  The  potassium  permanganate  (6f  ounces  to  every  1,000  cubic 
feet  of  room  space,  or  10  ounces  at  temperature  below  60°  F.)  should  be 
placed  in  the  apparatus  or  generator.  The  permanganate  must  he  put  in 
before  the  formaldehyde  solution. 

3.  The  40  per  cent  formaldehyde  solution  (16  ounces  to  the  1,000 
cubic  feet  of  room  space,  or  24  ounces  at  temperature  below  60°  F.) 
should  then  be  poured  over  the  permanganate. 

4.  As  the  gas  is  given  off  in  immense  volume  immediately  after  the 
mixture  of  the  formaldehyde  and  permanganate,  the  operator  must 
leave  the  room  at  once.  All  preparations  must  have  been  finished  in 
advance. 

5.  The  door  or  window  of  exit  must  be  promptly  closed  and  sealed, 
so  that  there  will  be  no  escape  of  gas,  and  the  room  should  be  left  closed 
for  four  hours. 

6.  The  room  should  be  thoroughly  cleaned  after  disinfection.  AH 
out-of-the-way  places,  window  ledges,  mouldings,  etc.,  should  be  washed 
with  Standard  Disinfectant  No.  3  (see  page  26).  The  floors  should 
receive  careful  attention  and  the  solution  should  thoroughly  wet  the  dust 
and  dirt  in  the  cracks. 

Whenever  practicable  the  special  generator  previously  described 
should  be  used,  and  health  officers  and  physicians  should  have  several 
such  containers  on  hand.  In  the  absence  of  such  a  container,  however, 
a  milk  pail  may  be  used,  as  indicated  on  page  22.  In  an  emergency  use 
any  tin  pail  or  crock,  of.  proper  size,  but  be  sure  and  ivell  heat  the  pail 
or  crock  before  putting  in  the  chemicals.  This  heating  is  very  important 
to  the  proper  generation  of  the  gas. 


24 

Care  must  be  taken  not  to  place  too  much  formaldehyde  in  a  single 
container.  The  reaction  is  violent  and  there  is  great  effervescence  and 
bubbling.  If  the  room  is  too  large  to  be  disinfected  with  one  generator, 
use  as  many  more  as  are  required  and  place  in  each  only  a  reasonable 
amount. 

The  following  quantities  may  be  used  safely  in  the  containers  recom- 
mended : 

10  or  12  quart  milk-pail,  Formaldehyde,  16  ounces; 

Permanganate,  6%  ounces. 
14  quart  milk-paiL  Formaldehyde,  24  ounces; 

Permanganate,  10  ounces. 
Special  apparatus  described  on  page  22,  and  illustrated  below. 

Formaldehyde,   32  ounces; 

Permanganate,   13 1/^   ounces. 


CONTAINER  FOR  GENERATING   FORMALDEHYDE  GAS. 
(Formaldehyde-Potassium   nermanaranate   method^ 


Larger  quantities  than  these  should  not  be  used. 

If  good  results  are  to  be  attained,  care  must  be  exercised  to  secure 
the  best  quality  of  formaldehyde  solution.  Secure  the  highest  grade 
40  per  cent  aqueous  solution  on  the  market.  Good  formaldehyde  is  not 
expensive.  Inferior  formaldehyde  is  dear  at  any  price.  Its  use  may 
bring  about  most  unfortunate  results. 

The  fine,  needle-shaped  crystals  of  potassium  permanganate  are  better 
than  the  rhomboid  crystals.  See  that  you  get  crystals  of  potassium  per- 
manganate.   Do  not  accept  the  dust,  which  often  contains  impurities. 

Prepare  the  room  and  its  contents  as  described  on  pages  9  and  10,  but 
remember  that  books  cannot  be  disinfected  with  formaldehyde  gas. 

Don't  use  "Formaldehyde  Candles/'  Don't  rely  on  the  apparatus 
which  the  energetic  and  anxious-to-mahe-a-sale  tradesman  tells  you  is 
tetter  than  that  recommended  by  the  State  Board  of  Health. 

Entire  dependence  should  not  be  placed  upon  any  aerial  disinfectant, 
even  though  its  penetrating  power  be  great.  There  should  be  a  thorough 
"house  cleaning"  after  the  exposure  to  the  gas,  and  the  liberal  appli- 
cation of  a  solution  of  corrosive  sublimate  to  all  exposed  surfaces  in  the 
room  and  a  thorough  outdoor  airing  of  its  contents. 


A  copy  of  this  circular,  liberal  supplies  of  which  can  be  secured  on 
application  to  the  Secretary  of  the  Board  at  Springfield,  should  be 
furnished  to  every  family  in  which  there  is  a  case  of  diphtheria  or 
"sore  throat,"  and  to  other  families  which  may  have  been  exposed  to  the 
disease,  and  also  to  teachers  of  public  and  private  schools  and  pastors  of 
churches. 

If  the  spirit  of  the  rules  and  regulations  of  the  State  Board  of  Health 
be  complied  with,  the  disease  can  be  easily  controlled  and  speedily  sup- 
pressed. 

Published  by  order  of  the  State  Board  of  Health. 

James  A.  Egan,  M.  D., 

Secretary. 


2G 


STANDARD  DISINFECTANTS. 


The  following  are  simple^  cheap  and  reliable  disinfectants. 
Standard  Disinfectant  No.  1. 

Dissolve  chloride  of  lime  of  the  hest  quality  in  water,  in  the  propor- 
tion of  six  ounces  to  the  gallon. 

Use  one  quart  of  this  solution  for  each  discharge  from  a  patient 
suffering  from  a  contagious  or  infectious  disease.  Discharges  from  the 
mouth  and  throat  should  be  received  in  a  cup  half  full  of  the  solution, 
and  those  from  the  nostrils  upon  soft  cotton  or  linen  rags,  which  should 
be  immediately  burned. 

The  chloride  of  lime  must  le  of  the  best  quality.  Poor  chloride  of 
lime  is  worthless.    The  solution  should  he  made  when  required. 

Instead  of  chloride  of  lime,  carbolic  acid  may  be  used  in  the  strength 
of  six  and  one-half  ounces  to  the  gallon  of  water. 

Standard  Disinfectant  No.  2. 

Dissolve  corrosive  sublimate  and  muriate  of  ammonia  in  water  in 
the  proportion  of  two  drachms  (120  grains — |  ounce)  of  each  to  the 
gallon.    Dissolve  in  a  wooden  tub,  barrel  or  pail,  or  an,  earthen  crock. 

Use  for  the  same  purposes  and  in  the  same  way  as  No.  1.  Equally 
effective,  but  slower  in  action.  This  solution  is  odorless,  while  the 
chloride  of  lime  solution  is  often  objectionable  in  the  sick  room  on 
account  of  its  smell. 

Standard  Disinfectant  No.  3. 

Dissolve  one  drachm  (60  grains — |  ounce)  of  corrosive  sublimate 
and  muriate  of  ammonia  in  one  gallon  of  water.  Dissolve  in  a  wooden 
tub,  barrel  or  pail,  or  an  earthen  croch. 

Use  for  the  disinfection  of  soiled  underclothing,  bed  linen,  etc.  Mix 
solution  and  immerse  articles  for  two  hours.  Then  wring  them  out  and 
boil  them. 


27 
Mixed  with  an  equal  quantity  of  water  the  solution  is  useful  for 
washing  the  hands  and  general  surfaces  of  the  bodies  of  attendants  and 
convalescents.     The  latter  only  by  direction  of  the  physician. 


Good  chloride  of  lime  should  contain  at  least  25  per  cent  of  available 
chlorine.  It  may  be  purchased  by  the  quantity  at  3|-  cents  per  pound. 
The  cost  of  the  standard  solution  recommended  is  therefore  about  1  cent 
a  gallon.  A  clear  solution  may  be  obtained  by  filteration  or  by  decanta- 
tion,  but  the  insoluble  sediment  does  no  harm,  and  this  is  an  unnecessary 
refinement. 

Ji@°=  Chloride  of  lime,  carbolic  acid  and  corrosive  sublimate  are 
deadly  poisons. 

S^^  Solutions  of  corrosive  sublimate  must  not  be  made  or  kept  in 
a  metal  vessel.    Use  a  wooden  tub,  barrel  or  pail  or  an  earthen  crock. 

S^-  Solutions  of  chloride  of  lime,  carbolic  acid  and  corrosive  subli- 
mate will  injure  lead  pipes  if  passed  through  them  in  large  quantities 
without  free  flushing. 

Standaed  Disinfectant  IsTo.  4. 

MILK  OF  LIME    (QUICK  LIME)  , 

Slack  a  quart  of  freshly  burnt  lime  (in  small  pieces)  ^ith  three- 
fourths  of  a  quart  of  water — or,  to  be  exact,  60  parts  of  water  by  weight 
with  100  of  lime.  A  dry  product  of  slack  lime  (hydrate  of  lime) 
results.  Make  milk  of  lime  not  long  before  it  is  to  be  used  by  mixing  one 
part  of  this  dry  hydrate  of  lime  with  eight  parts  (by  weight)  of  water. 

Air-slacked  lime  is  worthless.  The  dry  hydrate  may  be  preserved 
some  time  if  it  is  enclosed  in  an  air-tight  container.  Milk  of  lime  should 
be  freshly  prepared,  but  may  be  kept  a  few  days  if  it  is  closely  stoppered. 

Quick  lime  is  one  of  the  cheapest  of  disinfectants.  The  solution  can 
take  the  place  of  chloride  of  lime,  if  desired.  It  should  be  used  freely, 
in  quantity  equal  in  amount  to  the  material  to  be  disinfected.  It  can 
be  used  to  whitewash  exposed  surfaces,  to  disinfect  excreta  in  the  sick 
room  or  on  the  surface  of  the  ground,  in  sinks,  drains,  stagnant  pools,  etc. 


28 


IMPORTANT  NOTICE. 

The  Illinois  State  Board  of  Health  has  published  a  circular  on  the 
CAUSE  AND  PEEVENTION  OF  CONSUMPTION,a  preventable  and 
curable  disease^  but  one  which  kills  between  8,000  and  9,000  persons  in 
Illinois  every  year, — kills  men  and  women  in  their  prime. 

This  circular  contains  chapters  on  the  following  subjects :  The 
Cause  of  Consumption,  The  Symptoms  of  Consumption,  How  to 
Avoid  Consumption,  How  the  Sputum  May  Be  Destroyed,  If  You 
Have  Consumption,  The  Hygiene  of  the  Sick-room,  Consumption 
in  Schools,  As  to  Change  of  Climate,  and  As  to  the  Treatment 
of  Consumption  in  Illinois. 

Copies  of  this  circular  will  be  sent  free  of  charge  to  any  resident  of 
Illinois  who  applies  to  the  Secretary  at  Springfield. 

J|@°'In  consumption,  as  in  all  diseases,  it  is  essential  that  the  prem- 
ises be  kept  in  a  sanitary  condition.  All  decaying  animal  and  vegetable 
matter  and  every  kind  and  source  of  filth  in  and  about  the  house  should 
be  removed  and  disinfectants  freely  used.  Surface  drains  and  gutters, 
out  houses,  privies,  shelters  for  domestic  animals,  fowls,  etc.,  and  base- 
ments and  cellars  should  receive  close  and  constant  attention  and 
Standard  Disinfectants  No.  1  or  4  should  be  used  freely  and  regularly 
in  such  cases. 


The  Illinois  Circular  on  Consumption. 

"We  have  received  a  copy  of  a  circular  just  issued  by  the  Illinois 
State  Board  of  Health  on  'The  Cause  and  Prevention  of  Consumption.' 
We  regard  it  as  the  most  complete  and  compact  statement  of  the  cause 
and  prevention  of  this  all-too-universal  and  fatal  disease  that  we  have 
seen.  If  a  copy  of  it  could  be  put  in  every  home  in  the  land  and  was 
read  and  its  precepts  heeded,  consumption  would  be  reduced  fifty  per 
cent  in  ten  years." — From  Iowa  Health  Bulletin,  August,  1904,  pub- 
lished by  the  Iowa  State  Board  of  Health. 


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